Adult leg length is particularly sensitive to environmental factors and diet in early childhood because that is the period of most rapid leg growth. Trunk growth is faster than leg growth after infancy and before puberty, and may be associated with the effects of serious illness and parental separation because of the child's growing sensitivity to stressful circumstances, as well as the result of the biological effects of illness.
The aim of the present study was to establish whether the characteristics of members of a large national birth cohort study who submitted diet diaries with implausibly low-energy intake differed from those whose recorded energy intake was more plausible. Survey members (n 1898) recorded their diets in a 7 d diary in household measures. Those whose reported energy intake (EI) as'a fraction of their estimated BMR was less than 1.10, here termed low-energy reporters (LER) but often called under-reporters, constituted 206% of the study population. None of the variables describing dietary, smoking or exercise behaviour bore a significant relationship with low EI/BMR (t1.10), neither did those describing region of residence, subjective adequacy of income, current social class, social relations or the social environment of the subjects. Results of logistic regression analysis showed that the only independently significant characteristic for men was higher BMI. In women, in addition to higher BMI, having been overweight or obese as an adult independently, but less sipitlcantly, predicted low EI/BMR, while membership as a child of social class III (nonmanual), having more children in the household and having a paid job marginally but independently decreased the probability of reporting low EI/BMR. Submission of a diary with EI/BMR < 1.10 7 years earlier in the same survey was an even more powerful predictor of current low EI/BMR than higher BMI in both sexes. The average reported diet-composition of LER was more micronutrient-and protein-rich than that of the others, indicating different dietary, or dietrecording, behaviour in this group of subjects. LER are not a random sample of the survey population, and their characteristics, definable to some extent, put them at risk for lower health status. Although EI/BMR cut-off points can be used to identify LER, the problem of how to use their data is still unresolved. Dietary survey: Under-reporters: Energy intakeThere is an increasing awareness that under-reporting of food intake may occur to a significant extent in dietary surveys, no matter how much care is taken to coax full and accurate information from the subjects. Now that data are becoming available on the energy cost of various levels of activity in free-living individuals, it is becoming a convention to express reported energy intake (EI) as a multiple of BMR and to use this index (EI/BMR) in relation to expected energy expenditure (EE) as a validity check for negative bias in EI Goldberg et al. 1991;Bingham, 1994).Having established that there are low EI/BMR values in a dataset, there is uncertainty as to whether, or how, to use these data. The concern is that this phenomenon produces
The energy intake of 143 pregnant and lactating Gambian women was measured prospectively each week for a year. Anthropometric, birth weight, and breast milk output measurements were also obtained. The average energy intakes (+/- SE) during the dry and wet seasons respectively were: pregnancy, 1483 +/- 22 and 1417 +/- 41 kcal/day; lactation (1st trimester), 1773 +/- 31 and 1474 +/- 42 kcal/day; lactation (subsequent trimesters), 1662 +/- 16 and 1413 +/- 37 kcal/day. Pregnant women gained 1.4 kg body weight per month in the dry season, but only 0.4 kg in the wet season. Lactating women gained weight in the dry season and lost weight in the wet season. Maternal nutritional status did not deteriorate with increasing parity. Mean birth weights (+/- SE) were: 2.94 +/- 0.07 and 2.78 +/- 0.11 kg in dry and wet seasons, respectively. Breast milk output and quality and early infant growth were close to values from well-nourished communities during the dry season, but deteriorated markedly during the wet season. Wet season energy intakes were clearly inadequate, but these results indicate that, despite being low by international standards, the dry season intake was compatible with a good lactational performance. Except for a somewhat low birth weight, which is partly explained by small maternal stature, progress during pregnancy was also remarkably normal during the dry season.
A diary method using household measures was employed to obtain dietary records in a large national prospective survey and a computer program, DIDO (Diet In Data Out), was designed for direct entry of the diaries. The accuracy of this computerized coding system was examined alongside that of the manual coding used for a similar diary in a previous wave, 7 years earlier, of the same survey. Accuracy was assessed by analysis of the errors in the coded and checked records by stringent re‐checking of nominal 2% random subsamples of the diet diaries coded by each method. The mean time to code and check each of the 2086 7‐day records in the whole survey using DIDO was 58 minutes (SD 30) compared with reported results of 1–4 hours for manual methods. The mean error rate of computerized coding and checking with DIDO was 2.3% (SD 2.1; range 0–8.9) per diary in the subsample. Correcting these mistakes made insignificant changes to the calculated mean energy and nutrient intakes for the subsample. The percentage of individuals changing to an adjacent third of nutrient distribution after correcting unambiguous errors ranged from none (for alcohol) to 11% (for carbohydrate and calcium intake). The mean error rate on a similar subsample of diaries from the earlier survey which had been coded manually was significantly higher at 5.9% (SD 4.1; range 0–17) per diary. Emphasis is laid on the importance, in coding, of dealing with ambiguities in the subjects' records, since this can affect the accuracy and the precision of the nutrient results obtained. We conclude that the DIDO coding method has the advantages of greater accuracy, speed, consistency and efficient data handling, and affords greater data accessibility for checking, compared with manual systems.
The fat requirements of children can be judged according to 4 criteria: 1) the possible obligate needs of fat as a metabolic fuel, 2) the provision of a sufficiently energy-dense diet to meet energy needs, 3) the adequate supply of essential fatty acids, and 4) the supply of sufficient fat to allow adequate absorption of fat-soluble vitamins. In these respects the fat requirements of children in developing countries are probably similar to those of children in affluent nations except for the additional needs imposed by environmental stresses, particularly recurrent infections. In many developing countries, the low energy density of weaning foods appears to be a major contributor to growth faltering and ultimate malnutrition. Evidence from doubly labeled water studies suggests that these diets are adequate when children are healthy but fail to support rapid catch-up growth after diarrhea and other infections. The issues in determining and meeting the fat needs of children in developing countries are illustrated with use of detailed comparative dietary data from a rural community in The Gambia and from Cambridge, United Kingdom. The outstanding feature of the Gambian data is the great importance of breast milk as a source of fat and essential fatty acids up until the end of the second year of life. Weaning foods and adult foods contain low amounts of fat, which causes a sharp transition from adequate fat intakes to probable inadequate fat intakes when children are weaned from the breast. The effects of such low fat intakes, particularly in terms of immune function, require investigation.
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